Considerations for Adolescent and Adult Milestones

Ronna Linroth, OT, PhD, CCP30th Annual Conference for Professionals in Brain Injury

Thursday, April 9, 2015

Learning ObjectivesO Participants will identify the four

primary areas of emerging adult milestones

O Participants will have a working definition of Transition as a process.

O Participants will assess their program for needed next steps for professional and patient support during transition.

Brain developmentO There is now no doubt that adolescence

should be treated as a special period.O Striking changes in the white and gray matter

take place between 11 and 25 years of age.O May lead to abrupt behavioral change &

attendant risk.O Brain becomes flexible and able to respond

quickly and imaginatively.O Healthcare providers need to approach health

management within the context of transition to adulthood.

Pediatric Head Injury“Severe head injury in childhood may appear to be followed by striking recovery to the developmental stage the child had reached before injury. However, after a number of settled years significant behavioral, attentional and psychological problems may then appear in the teenage years due to underlying damage to the grey matter and the white matter tracts being masked until the maturation phases of adolescent brain development begin.”

O Colver & Longwell, (2013), pg 904

Transition Early stage 12-14Middle stage 15-17 Late stage 18+

Healthcare TransitionO Transition is the planned process

[preparation] and purposeful movement into adult oriented care (Patterson, 1999).

O Transfer of care is an event or events- the switch from pediatric oriented medical care providers to adult oriented medical care providers.

Components of Successful Transition

OSelf-DeterminationOPerson Centered PlanningOPreparation for adult health

careOWork /Independence OInclusion in community life

Introducing the theory of Emerging Adulthood

Emerging Adult MilestonesJeffrey Arnett in 2000, American Psychology

O A phase of the lifespan between late adolescence and full-fledged adulthood

O (age 18-29)O Applies to young adults in

developed countries whoO Do not have childrenO Do not live in their own homeO Do not have sufficient income to

become fully independent

Cognitive Development during this phase:

O Connections within the brain are still being strengthened and unused are pruned

O Brain structures develop for O greater processing of emotions and social

informationO greater planning and assessment of risk/rewards

O “Emerging adulthood is a critical stage for the emergence of complex forms of thinking required in complex societies.”

(Gisela Labouvie-Vief, 2006)

5 features of emerging adults

O Age of identity exploration. O Age of instability. O Age of self-focus. O Age of feeling in between. O Age of possibilities.

Emerging adults want a lot out of life!

OSome struggle and some prosper

O How well an adolescent makes the transition through young adulthood into adulthood and becomes a fully independent person depends in large part on the right balance of the adolescent pushing for independence and parents and society giving the correct amount of support--not pushing too hard or holding back too much. (Tanner, 2004)

Two processes occurring in Emerging Adults

O Re-centering: Shifting from dependence on parents to system commitments (careers, intimate partners, children)

O Ego Development: agency, self-regulation, impulse control, learning to stand alone, constructing life plans

Arnett’s 4 areas of focus

OEmploymentOEducationOIndependent livingOMaturing relationships

Gillette’s Transition Clinic

O Designed to assist patients and families in their transition from a pediatric care model to an adult care model.

O Help is provided to assist in identifying skills and knowledge needed to navigate the adult specialty healthcare environment.

O Visit includes review of medical history, readiness self-assessment, interview, goal-setting, referrals to services needed to assure continuity of care.

Most frequently identified needs through screening tool:• Assistance with

transportation• Future living

situation, i.e., group home, remain with family, independent living• Future vocation

Lessons Learned Patients and families present as unprepared for

transition. Parent needs for transition support are often as great as those of patient. Discussion needs to start early

Creation and distribution of educational tools to providers, staff, and families is essential.

Most transition patients do not carry any identification

Attachments between patient/family and pediatric providers/staff is very strong

Lessons, continued Pediatric primary care providers have told

many patients to find an adult primary care provider. This is proving difficult for many patients and families

Difficult and often emotional when parent is asked to leave the patient alone with provider

Care coordination is essential for successful transition.

Assessing for Transition Support

Six Core Elements for Health Care Transition

Transition supports are needed during adolescence and early adulthood

“It is sort of unfair to expect [teens] to have adult levels of organizational skills or decision-making before their brains are finished being built.”

Resourcesgottransition.org is the website for the Center for Health Care Transition

ReferencesO "Emerging Adulthood: The Winding Road

From the Late Teens Though the Twenties“, 2nd Ed. (Oxford University Press, 2014).

O “Pediatric to Adult Transition: A Quality Improvement Model for Primary Care”(2014) Journal of Adolescent Health, 56, 73-78.

O Credit for images: Bing.comhttp://www.bing.com/images/search?q=images+of+brain+development&qpvt=images+of+brain+devleopment&qpvt=images+of+brain+devleopment&FORM=IGRE

Answers are not guaranteed but we can have a great discussion!

Thank you!